The scalar politics of infectious disease governance in an era of liberalised air travel

Fears about the continued spread of the incurable Ebola virus have reached new heights in recent days, linked to uncertainties about the ability to contain diseases in an era of liberalised air transport. Over the last eight months around 916 people have died of the disease in Guinea, Liberia and Sierra Leone. It now appears the disease has spread to Lagos in neighbouring Nigeria, with eight confirmed cases. In recent months several international aid workers, healthcare workers and missionaries have also fallen victim to the disease, travelling back to Europe and North America for treatment, prompting fears about the greater spread of the disease. Subsequently, the WHO has now labelled the current outbreak as an ‘international emergency’.

In a paper from 2011 in the Transactions of the Institute of British Geographers, Lucy Budd and colleagues considered the impacts of liberalised air transport and changes in infectious disease governance in the aftermath of the SARS and H1N1 infectious disease scares. They argued that vast increases in air passenger numbers and the growing frequency and geographical extent of long haul flights raised new challenges for international disease governance and sanitary preemption. This increased global mobility of human populations creates within itself the potential for this mobility to be disrupted and curtailed through the spread of pathogens. Infectious disease governance and prevention depends on the cooperation of a web of national, regional and global agencies – with different and sometimes contested responsibilities – while practices of disease containment must be performed within in an increasing number of highly localised sites, from the airport security line, to the local clinic and the morgue.

The ongoing Ebola outbreak points to further scalar concerns around the governance of deadly infection diseases. Recent debates have focussed on the potential for using experimental treatments imported from the West to treat Ebola victims in attempt to improve the disease’s 50% mortality rate and curtail its further spread. A key question around this is to what extent standards of bioethics within the countries where these experimental treatments were developed should also be imported to the affected countries, counselling caution around the use of untested treatments. Furthermore, whilst the treatment of the disease requires the participation of international agencies, experts and technologies, it must also understand and respect the specific values and practices of Ebola victims and their families in order to be effective.

So whilst there are clear ethical dimensions to the governance of the Ebola outbreak there is also a strong scalar dimension. The successful containment and treatment of the disease depends not only on international and national cooperation, but on the micro-practices within the multiple locations of the sanitary border.